Healthcare Provider Details

I. General information

NPI: 1316072424
Provider Name (Legal Business Name): RICHARD ROSEN ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6544 FRONT ST.
FORESTVILLE CA
95436-1713
US

IV. Provider business mailing address

PO BOX 1713
FORESTVILLE CA
95436-1713
US

V. Phone/Fax

Practice location:
  • Phone: 707-887-1165
  • Fax: 707-887-2184
Mailing address:
  • Phone: 707-887-1165
  • Fax: 707-887-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6678
License Number StateCA

VIII. Authorized Official

Name: MR. RICHARD STUART ROSEN
Title or Position: PRESIDENT
Credential: L.AC.
Phone: 707-887-1165